| Authentic Life Counseling And Wellness, Pllc | |
|
1200 W Eleventh St Suite 218 Traverse City MI 49684-3287 | |
| (231) 714-0292 | |
| Not Available |
| Full Name | Authentic Life Counseling And Wellness, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 1200 W Eleventh St, Traverse City, Michigan |
| Authorized Official Name and Position | Kristina Wiersema (OWNER) |
| Authorized Official Contact | 2317140292 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Authentic Life Counseling And Wellness, Pllc 13554 S High Point Dr Traverse City MI 49684-5534 Ph: (231) 714-0292 | Authentic Life Counseling And Wellness, Pllc 1200 W Eleventh St Suite 218 Traverse City MI 49684-3287 Ph: (231) 714-0292 |
| NPI Number | 1518404128 |
|---|---|
| Provider Enumeration Date | 01/21/2017 |
| Last Update Date | 01/21/2017 |
| Medicare PECOS PAC ID | 4486937554 |
|---|---|
| Medicare Enrollment ID | O20170215001972 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518404128 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | 6801093573 (Michigan) | Primary |
| Provider Name | Kristina Kaye Wiersema |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346517513 PECOS PAC ID: 2668790965 Enrollment ID: I20150417000091 |
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